Preemptive analgesia in children. Does it exist?

BACKGROUND AND OBJECTIVES: Preemptive analgesia has been evident in animals, but few adult human studies exist demonstrating this concept exist, and there are fewer still in children. Caudal epidural blocks with local anesthetics are often placed for postoperative analgesia in children. This study evaluated whether these blocks are more effective when placed prior to surgical incision. METHODS: Children aged 1-6 years and ASA I and II (n = 51), undergoing elective herniorrhaphy, orchidopexy, or circumcision were randomly assigned to receive a caudal epidural block with 0.6 mL/kg of 0.25% bupivacaine with 1:200,000 epinephrine, either before incision (n = 28) or after surgery (n = 23). In all patients, anesthesia was induced and maintained with oxygen, nitrous oxide, and halothane, and caudal epidural blocks were placed. Postoperative pain was scored by a blinded observer using a Faces Pain Scale in the recovery room and was also assessed at home by the parents. Analgesic requirement during the 24-hour period was recorded. RESULTS: The Faces Pain Scale scores and analgesic requirements did not differ between the groups, either in the recovery room or at home (P > .05). CONCLUSIONS: Although preemptive analgesia has been successfully demonstrated in some earlier clinical studies, our results indicate that pre- and postincisional caudal epidural blocks with 0.25% bupivacaine were equally effective in children.

Chronic pain and disease conviction.

OBJECTIVE: The results of cross-sectional and prospective studies suggest that the disease conviction scale of the Illness Behavior Questionnaire (IBQ) provides important information about chronic pain. To examine further the characteristics and correlates of this scale, the relationships between disease conviction and average pain intensity and interference of pain with daily activities were examined in a sample of chronic pain patients. DESIGN: The disease conviction scale and measures of hypochondriasis, psychological distress, pain intensity, and pain interference were administered to a sample of 127 chronic pain patients. RESULTS: The results suggested that pain intensity and interference were more strongly associated with disease conviction than with measures of psychological distress and hypochondriasis. In an analysis in which the relationships between the individual items of the disease conviction scale and pain intensity and interference were examined, disease conviction scale items that reflect consequences of pain and illness were significantly associated with both pain intensity and pain interference, whereas items that reflect disease conviction were in general not associated with either pain intensity or interference. CONCLUSION: These results suggest that items included in the disease conviction scale that reflect consequences of pain and illness, rather than disease conviction, may have contributed to the relationships that have been reported between disease conviction and other aspects of the chronic pain experience.